The present invention relates to surgical instruments, and particularly to laparoscopic instruments which facilitate the performance of laparoscopic procedures entirely through the umbilicus.
Abdominal laparoscopic surgery gained popularity in the late 1980""s, when benefits of laparoscopic removal of the gallbladder over traditional (open) operation became evident. Reduced post-operative recovery time, markedly decreased post-operative pain and wound infection, and improved cosmetic outcome are well established benefits of laparoscopic surgery, derived mainly from the ability of laparoscopic surgeons to perform an operation utilizing smaller incisions of the body cavity wall.
Laparoscopic procedures generally involve insufflation of the abdominal cavity with CO2 gas to a pressure of around 15 mm Hg. The abdominal wall is pierced and a 5-10 mm in diameter straight tubular cannula or trocar is then inserted into the abdominal cavity. A laparoscopic telescope connected to an operating room monitor is used to visualize the operative field, and is placed through one of the trocars. Laparoscopic instruments (graspers, dissectors, scissors, retractors, etc.) are placed through two or more additional trocars for the manipulations by the surgeon and surgical assistant(s).
Generally, one or two trocars are used by the surgeon (active trocars), while one or two additional trocars are utilized by a surgical assistant for organ and/or tissue retraction (passive trocars). For example, laparoscopic cholecystectomy (gallbladder removal) is generally performed using four trocars: one is placed in the umbilicus (belly button) for a telescope, a second is inserted approximately 3 inches above the umbilicus for use as an active trocar by the surgeon, and two additional passive trocars are positioned on the right side of the abdomen to enable a surgical assistant to retract the gall bladder. As a result of this procedure, the gall bladder is extracted through the umbilicus.
It is often required to increase the umbilical incision to 2-3 cm or more to accommodate a thick, enlarged gall bladder. As a result, the incision and subsequent scar in the umbilicus is not visible, however, the three non-umbilical incisions leave permanent 5-10 mm scars. In addition, the non-umbilical incisions are a source of potential complications including bleeding, infection, scar formation, and pain. Recently, so-called xe2x80x9cmini-laparoscopyxe2x80x9d has been introduced utilizing 2-3 mm diameter straight trocars and laparoscopic instruments. When successful, mini-laparoscopy allows further reduction of abdominal wall trauma and improved cosmesis. However, instruments used for mini-laparoscopic procedures are very expensive and fragile. Because of their poor durability, mini-laparoscopic instruments can be used only on patients with very thin abdominal walls, which represents a small percentage of patients requiring an abdominal laparoscopic procedure. In addition, 2-3 mm scars, although small, still may be a source of an undesirable cosmetic outcome and potential wound complications. Further, some patients develop keloid or hypertrophic scar tissue formation even using 2-3 mm incisions.
When conventional trocars and conventional laparoscopic instruments are inserted only through the umbilicus of the patient, the close proximity of the instruments to each other results in the so-called xe2x80x9cchopstick effectxe2x80x9d, which is a significant limitation to the manipulation of conventional laparoscopic instruments through conventional trocars. This xe2x80x9cchopstick effectxe2x80x9d describes the interference between the surgeon""s hands as well as the interference between the laparoscopic instruments. Laparoscopic procedures require complex movements within three-dimensional space, including both the workspace inside the patient""s abdominal cavity and the area outside the patient""s abdominal cavity occupied by the proximal portions of the laparoscopic instruments and the surgeon""s hands. When the handles for laparoscopic instruments and the surgeon""s hands are immediately adjacent to each other, as is the case in conventional laparoscopic procedures, the surgeon""s left and right hands inevitably make contact. In addition, contact between each of the instrument""s shafts can occur. This contact markedly restricts the movement of the surgeon""s hands of each instrument, both separately and in relation to each other, hence greatly reducing the surgeon""s ability to perform a described procedure and significantly increasing the skill level needed to perform the procedure.
Thus, there is a need for instruments and trocar systems which allow laparoscopic procedures to be performed entirely through the umbilicus while at the same time reducing or eliminating the above-described xe2x80x9cchopstick effectxe2x80x9d. Performance of a laparoscopic procedure entirely through the umbilicus using the laparoscopic instruments and trocar system according to an embodiment of the present invention can improve significantly the surgeon""s access to various abdominal structures and the cosmetic outcome of laparoscopic procedures, while reducing the degree of operative and post-operative complications.
The present invention provides laparoscopic instruments and trocars for the performance of laparoscopic procedures entirely through the umbilicus.
An object of the present invention is to provide a laparoscopic instrument-trocar unit, which markedly increases the work space between the hands of the surgeon when the laparoscopic instrument-trocar units are placed through the umbilicus.
An additional object of the present invention is to provide a generally C-shaped trocar, which facilitates reduction in the interference between manipulated laparoscopic instruments.
Another object of the present invention is to provide generally S-shaped laparoscopic instruments, where the proximal curve of xe2x80x9cSxe2x80x9d corresponds to the xe2x80x9cCxe2x80x9d curve of the C-shaped trocar creating separation between manually controlled ends of the laparoscopic instruments, while the distal curve of the xe2x80x9cSxe2x80x9d creates a markedly increased work space between laparoscopic instruments.
Another object of the present invention is to provide a stretchable and inflatable generally C-shaped trocar for accommodation of the rigid generally S-shaped laparoscopic instruments, which, when inflated creates a single unit with an S-shaped instrument.
Another object of the present invention is to provide an inflatable unit with at least one generally C-shaped trocar incorporated within the unit""s walls, which can be placed through the umbilicus following a single incision.
Another object of the invention is to provide an angulated needle with two sharp ends and a thread attached to the angle of the needle for use in organ retraction, which allows penetration of the abdominal wall, an intra-abdominal structure, and then the abdominal wall again without a change in the orientation of the needle.
A further object of the present invention is to provide an angulated needle having a long segment on one side of the angle which terminates in a sharp point and a shorter segment on the other side of the angle which has a thread attached to it.
According to an exemplary embodiment of the present invention, laparoscopic instruments and trocars are provided for performing laparoscopic procedures entirely through the umbilicus. A generally C-shaped trocar markedly increases the work space between the hands of the surgeon thereby reducing interference between the surgeon""s hands as well as the manipulated laparoscopic instruments, particularly when the laparoscopic instrument-trocar units are placed through the umbilicus. In order to facilitate retraction of intra-abdominal structures during a laparoscopic procedure, an angulated needle and thread with either one or two sharp ends is provided. Alternatively, an inflatable unit having at least one generally C-shaped trocar incorporated within the unit""s walls can be placed through the umbilicus following a single incision. Generally S-shaped laparoscopic instruments may be placed through the generally C-shaped trocars to facilitate access to intra-abdominal structures.